Bipolar disorder
Definition :
Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities.
When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.
Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).
Symptoms:
Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:
Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
Signs and symptoms of the depressive phase of bipolar disorder can include:
Signs and symptoms of bipolar disorder can also include:
Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.
When to see a doctor
If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.
Many people with bipolar disorder don't get the treatment they need. Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you're reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. They may be able to help you take the first steps to successful treatment.
If you have suicidal thoughts
Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.
Causes:
The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:
Complications:
Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These can include:
Bipolar disorder requires lifelong treatment, even during periods when you feel better. Treatment is usually guided by a psychiatrist skilled in treating the condition. You may have a treatment team that also includes psychologists, social workers and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group or family psychological counseling (psychotherapy); or education and support groups.
A number of medications are used to treat bipolar disorder. If one doesn't work well for you, there are a number of others to try. Your doctor may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.
Medications for bipolar disorder include:
Finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. This can take months or longer, and medications may need to be adjusted as your symptoms change. Side effects improve as you find the right medications and doses that work for you, and your body adjusts to the medications.
Medications and pregnancy
A number of medications for bipolar disorder can be associated with birth defects.
Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:
This treatment applies rapid pulses of a magnetic field to the head. It's not clear exactly how this helps, but it appears to have an antidepressant effect. However, not everyone is helped by this therapy, and it's not yet clear who is a good candidate for this type of treatment. More research is needed. The most serious potential side effect is a seizure.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy can be effective for people who have episodes of severe depression or feel suicidal or people who haven't seen improvements in their symptoms despite other treatment. With ECT, electrical currents are passed through your brain. Researchers don't fully understand how ECT works. But it's thought that the electric shock causes changes in brain chemistry that leads to improvements in your mood. ECT may be an option if you have mania or severe depression when you're pregnant and cannot take your regular medications. ECT can cause temporary memory loss and confusion.
Hospitalization
In some cases, people with bipolar disorder benefit from hospitalization. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider. These programs provide the support and counseling you need while you get symptoms under control.
Treatment in children and adolescents
Children and adolescents with bipolar disorder are prescribed the same types of medications as those used in adults. However, there's little research on the safety and effectiveness of bipolar medications in children, so treatment decisions are based on adult research. Treatments are generally decided on a case-by-case basis, depending on exact symptoms, medication side effects and other factors. As with adults, ECT may be an option for adolescents with severe bipolar I symptoms or for whom medications don't work.
Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy — along with working with teachers and school counselors — can help children develop coping skills, address learning difficulties and resolve social problems. It can also help strengthen family bonds and communication. Psychotherapy may also be necessary to resolve substance abuse problems, common in older children with bipolar disorder.
Definition :
Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities.
When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.
Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).
Symptoms:
Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:
- Bipolar I disorder. Mood swings with bipolar I
cause significant difficulty in your job, school or relationships. Manic
episodes can be severe and dangerous.
- Bipolar II disorder. Bipolar II is less severe than
bipolar I. You may have an elevated mood, irritability and some changes
in your functioning, but generally you can carry on with your normal
daily routine. Instead of full-blown mania, you have hypomania — a less
severe form of mania. In bipolar II, periods of depression typically
last longer than periods of hypomania.
- Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.
Bipolar disorder symptoms reflect a range of moods.
The exact symptoms of bipolar disorder vary from person to person. For
some people, depression causes the most problems; for other people,
manic symptoms are the main concern. Symptoms of depression and symptoms
of mania or hypomania may also occur together. This is known as a mixed
episode.Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
- Euphoria
- Inflated self-esteem
- Poor judgment
- Rapid speech
- Racing thoughts
- Aggressive behavior
- Agitation or irritation
- Increased physical activity
- Risky behavior
- Spending sprees or unwise financial choices
- Increased drive to perform or achieve goals
- Increased sex drive
- Decreased need for sleep
- Easily distracted
- Careless or dangerous use of drugs or alcohol
- Frequent absences from work or school
- Delusions or a break from reality (psychosis)
- Poor performance at work or school
Signs and symptoms of the depressive phase of bipolar disorder can include:
- Sadness
- Hopelessness
- Suicidal thoughts or behavior
- Anxiety
- Guilt
- Sleep problems
- Low appetite or increased appetite
- Fatigue
- Loss of interest in activities once considered enjoyable
- Problems concentrating
- Irritability
- Chronic pain without a known cause
- Frequent absences from work or school
- Poor performance at work or school
Signs and symptoms of bipolar disorder can also include:
- Seasonal changes in mood. As with seasonal
affective disorder (SAD), some people with bipolar disorder have moods
that change with the seasons. Some people become manic or hypomanic in
the spring or summer and then become depressed in the fall or winter.
For other people, this cycle is reversed — they become depressed in the
spring or summer and manic or hypomanic in the fall or winter.
- Rapid cycling bipolar disorder. Some people with
bipolar disorder have rapid mood shifts. This is defined as having four
or more mood swings within a single year. However, in some people mood
shifts occur much more quickly, sometimes within just hours.
- Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren't there (hallucinations).
Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.
When to see a doctor
If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.
Many people with bipolar disorder don't get the treatment they need. Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you're reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. They may be able to help you take the first steps to successful treatment.
If you have suicidal thoughts
Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
- Contact a family member or friend.
- Seek help from your doctor, a mental health provider or other health care professional.
- Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
- Contact a minister, spiritual leader or someone in your faith community.
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.
Causes:
The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:
- Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
- Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
- Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.
- Inherited traits. Bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.
- Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder.
Complications:
Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These can include:
- Problems related to substance and alcohol abuse
- Legal problems
- Financial problems
- Relationship troubles
- Isolation and loneliness
- Poor work or school performance
- Frequent absences from work or school
- Suicide
Bipolar disorder requires lifelong treatment, even during periods when you feel better. Treatment is usually guided by a psychiatrist skilled in treating the condition. You may have a treatment team that also includes psychologists, social workers and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group or family psychological counseling (psychotherapy); or education and support groups.
- Hospitalization. Your doctor may have you
hospitalized if you are behaving dangerously, you feel suicidal or you
become detached from reality (psychotic).
- Initial treatment. Often, you'll need to begin
taking medications to balance your moods right away. Once your symptoms
are under control, you'll work with your doctor to find the best
long-term treatment.
- Continued treatment. Maintenance treatment is used
to manage bipolar disorder on a long-term basis. People who skip
maintenance treatment are at high risk of a relapse of symptoms or
having minor mood changes turn into full-blown mania or depression.
- Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
A number of medications are used to treat bipolar disorder. If one doesn't work well for you, there are a number of others to try. Your doctor may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.
Medications for bipolar disorder include:
- Lithium. Lithium (Lithobid, others) is effective at
stabilizing mood and preventing the extreme highs and lows of certain
categories of bipolar disorder and has been used for many years.
Periodic blood tests are required, since lithium can cause thyroid and
kidney problems. Common side effects include restlessness, dry mouth and
digestive issues.
- Anticonvulsants. These mood-stabilizing medications
include valproic acid (Depakene, Stavzor), divalproex (Depakote) and
lamotrigine (Lamictal). The medication asenapine (Saphris) may be
helpful in treating mixed episodes. Depending on the medication you
take, side effects can vary. Common side effects include weight gain,
dizziness and drowsiness. Rarely, certain anticonvulsants cause more
serious problems, such as skin rashes, blood disorders or liver
problems.
- Antipsychotics. Certain antipsychotic medications,
such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone
(Risperdal) and quetiapine (Seroquel), may help people who don't benefit
from anticonvulsants. The only antipsychotic that's specifically
approved by the U.S. Food and Drug Administration (FDA) for treating
bipolar disorder is quetiapine. However, doctors can still prescribe
other medications for bipolar disorder. This is known as off-label use.
Side effects depend on the medication, but can include weight gain,
sleepiness, tremors, blurred vision and rapid heartbeat. Weight gain in
children is a significant concern. Antipsychotic use may also affect
memory and attention and cause involuntary facial or body movements.
- Antidepressants. Depending on your symptoms, your
doctor may recommend you take an antidepressant. In some people with
bipolar disorder, antidepressants can trigger manic episodes, but may be
OK if taken along with a mood stabilizer. The most common
antidepressant side effects include reduced sexual desire and problems
reaching orgasm. Older antidepressants, which include tricyclics and MAO
inhibitors, can cause a number of potentially dangerous side effects
and require careful monitoring.
- Symbyax. This medication combines the
antidepressant fluoxetine and the antipsychotic olanzapine. It works as a
depression treatment and a mood stabilizer. Symbyax is approved by the
FDA specifically for the treatment of bipolar disorder. Side effects can
include weight gain, drowsiness and increased appetite. This medication
may also cause sexual problems similar to those caused by
antidepressants.
- Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.
Finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. This can take months or longer, and medications may need to be adjusted as your symptoms change. Side effects improve as you find the right medications and doses that work for you, and your body adjusts to the medications.
Medications and pregnancy
A number of medications for bipolar disorder can be associated with birth defects.
- Use effective birth control (contraception) to prevent pregnancy. Discuss birth control options with your doctor, as birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.
- If you plan to become pregnant, meet with your doctor to discuss your treatment options.
- Discuss breast-feeding with your doctor, as some bipolar medications can pass through breast milk to your infant.
Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:
- Cognitive behavioral therapy. This is a common form
of individual therapy for bipolar disorder. The focus of cognitive
behavioral therapy is identifying unhealthy, negative beliefs and
behaviors and replacing them with healthy, positive ones. It can help
identify what triggers your bipolar episodes. You also learn effective
strategies to manage stress and to cope with upsetting situations.
- Psychoeducation. Counseling to help you learn about
bipolar disorder (psychoeducation) can help you and your loved ones
understand bipolar disorder. Knowing what's going on can help you get
the best support and treatment, and help you and your loved ones
recognize warning signs of mood swings.
- Family therapy. Family therapy involves seeing a
psychologist or other mental health provider along with your family
members. Family therapy can help identify and reduce stress within your
family. It can help your family learn how to communicate better, solve
problems and resolve conflicts.
- Group therapy. Group therapy provides a forum to
communicate with and learn from others in a similar situation. It may
also help build better relationship skills.
- Other therapies. Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with your daily routine and interpersonal relationships (interpersonal and social rhythm therapy). Ask your doctor if any of these options may be appropriate for you.
This treatment applies rapid pulses of a magnetic field to the head. It's not clear exactly how this helps, but it appears to have an antidepressant effect. However, not everyone is helped by this therapy, and it's not yet clear who is a good candidate for this type of treatment. More research is needed. The most serious potential side effect is a seizure.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy can be effective for people who have episodes of severe depression or feel suicidal or people who haven't seen improvements in their symptoms despite other treatment. With ECT, electrical currents are passed through your brain. Researchers don't fully understand how ECT works. But it's thought that the electric shock causes changes in brain chemistry that leads to improvements in your mood. ECT may be an option if you have mania or severe depression when you're pregnant and cannot take your regular medications. ECT can cause temporary memory loss and confusion.
Hospitalization
In some cases, people with bipolar disorder benefit from hospitalization. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider. These programs provide the support and counseling you need while you get symptoms under control.
Treatment in children and adolescents
Children and adolescents with bipolar disorder are prescribed the same types of medications as those used in adults. However, there's little research on the safety and effectiveness of bipolar medications in children, so treatment decisions are based on adult research. Treatments are generally decided on a case-by-case basis, depending on exact symptoms, medication side effects and other factors. As with adults, ECT may be an option for adolescents with severe bipolar I symptoms or for whom medications don't work.
Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy — along with working with teachers and school counselors — can help children develop coping skills, address learning difficulties and resolve social problems. It can also help strengthen family bonds and communication. Psychotherapy may also be necessary to resolve substance abuse problems, common in older children with bipolar disorder.
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